Failure of chronic hydroxychloroquine in preventing severe complications of COVID-19 in patients with rheumatic diseases

Pham et al., Rheumatology Advances in Practice, 10.1093/rap/rkab014

Mar 2021

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Tiny retrospective database analysis of hospitalized COVID-19 patients with rheumatologic disease containing 14 chronic HCQ and 28 control patients. Patients are very poorly matched. Bias against HCQ is clear in the abstract which mentions differences favoring HCQ but ignores those favoring control (large differences in ethnicity, rheumatic conditions, hypertension, coronary artery disease, solid organ transplant recipients, immunosuppresive drugs). 61% of control patients also received HCQ. Adherence for chronic HCQ patients was not examined. Despite the very large differences between the groups, no adjustments are made. The study claims that HCQ did not prevent severe cases, but the study is among hospitalized patients, i.e., they already have cases severe enough for hospitalization - this study can not identify a protective effect of HCQ that reduces the probability of disease severe enough for hospitalization.

Although the 20% lower mortality is not statistically significant, it is consistent with the significant 24% lower mortality [19‑28%] from meta analysis of the 244 mortality results to date.

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risk of death, 19.7% lower, RR 0.80, p = 0.77, treatment 2 of 14 (14.3%), control 5 of 28 (17.9%), NNT 28, odds ratio converted to relative risk, univariate.

risk of ICU admission, 35.5% higher, RR 1.35, p = 0.61, treatment 4 of 14 (28.6%), control 6 of 28 (21.4%), odds ratio converted to relative risk, univariate.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Pham et al., 2 Mar 2021, retrospective, USA, peer-reviewed, 5 authors.

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Failure of chronic hydroxychloroquine in preventing severe complications of COVID-19 in patients with rheumatic diseases

Khanh Pham, Heidi Torres, Michael J Satlin, Parag Goyal, Roy M Gulick

Rheumatology Advances in Practice, doi:10.1093/rap/rkab014

Objective To compare baseline characteristics, clinical presentations and outcomes of patients with rheumatic conditions requiring hospitalization for coronavirus disease 2019 (COVID-19) who received chronic HCQ with those who did not receive chronic HCQ. Methods We identified all patients with a rheumatologic disease who were admitted with COVID-19 to two hospitals in New York City between 3 March 3 and 30 April 2020. Patients who received chronic HCQ prior to admission were matched 1:2 (610 years of age) with patients who did not receive chronic HCQ. We compared demographics, comorbidities, HCQ dosages, concurrent medications, presentations and outcomes between the groups. Results There were 14 patients receiving HCQ and 28 matched control subjects. The median age of cases was 63 years [interquartile range (IQR) 43-73) and 60 years (IQR 41-75) for controls. Control subjects had a higher prevalence of pulmonary diseases (42.8%), diabetes (35.7%) and obesity (35.7%) than their case counterparts (28.6%, 14.3% and 7.1%, respectively). A higher proportion of cases than control subjects (50% vs 25%) reported the use of prednisone for their rheumatic conditions prior to admission. Despite these differences in baseline characteristics, univariate logistic regression revealed no statistically significant differences in the need for mechanical ventilation [OR 1.5 (95% CI 0.34, 6.38)] or in-hospital mortality [OR 0.77 (95% CI 0.13, 4.56)]. Conclusion HCQ therapy in individuals with rheumatic conditions was not associated with less severe presentations of COVID-19 among hospitalized patients compared with individuals with rheumatic conditions not receiving HCQ.

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